It
seems that most women with TTTS at mid-pregnancy are found
to be malnourished. Anemia, low blood protein, decreased calorie
intake and dehydration are common findings. Many women
with multiple gestations have morning sickness or poor appetites
that may be worse than that seen with only one baby. It may
be frustrating and upsetting not to be able to eat well. This
below normal intake of nutrients, combined with the needs
of twin babies and some of the mother's changes in TTTS (e.g.,
a womb that is more than twice the normal size for the time
of pregnancy) may all contribute to the development of malnutrition. There are
two unusual circumstances in TTTS that could make a mother's
weight go up despite decreasing her dietary intake. These
cause inaccuracies in determinations of nutritional status
when one weighs themselves on a scale:

1. When the recipient
develops polyhydramnious (excess amniotic fluid), this water
in the womb adds to the mother's weight.

2. The second is also water weight, but this
is the effect of swelling or edema that occurs throughout
the mother's body whenever her blood protein levels drop to
abnormally low levels.

The Foundation has explored a number of ways for women to
help solve this problem and found that the most efficient
way to recover the losses, and prepare for the rest of the
pregnancy, is to take liquid dietary supplements (e.g., Boost,
Carnation Instant Breakfast, Ensure Plus, and others that
are soy based) sipped slowly, continuously throughout the
day in addition to whatever you can eat at meals. If the morning
sickness is still present, encourage your patient to try her
best with the supplements and liquids until it passes. The sensation
of thirst is also common, and seems unusual in the face of
excess body water. We recommend soy milk or athletic drinks
(e.g., Gatorade.) to provide more than just water the mom
and her babies.